使用替诺福韦后无肾功能损害的远端肾小管酸中毒：一例报告
Distal renal tubular acidosis without renal impairment after use of tenofovir: a case report.
作者信息
Iwata Kentaro, Nagata Manabu, Watanabe Shuhei, Nishi Shinichi
机构信息
Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo, Japan, 650-0017.
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kusunokicho 7-5-2, Chuoku, Kobe, Hyogo, Japan, 650-0017.
出版信息
BMC Pharmacol Toxicol. 2016 Nov 21;17(1):52. doi: 10.1186/s40360-016-0100-y.
BACKGROUND
Tenofovir, one of antiretroviral medication to treat human immunodeficiency virus (HIV) infection, is known to cause proximal renal tubular acidosis such as Fanconi syndrome, but cases of distal renal tubular acidosis had never been reported.
CASE PRESENTATION
A 20-year-old man with HIV infection developed nausea and vomiting without diarrhea after starting antiretroviral therapy. Arterial blood gas revealed non-anion-gap metabolic acidosis and urine test showed positive urine anion gap. Tenofovir, one of antiretroviral medicine the patient received, was considered to be the cause of this acidosis and all antiretroviral drugs were discontinued. Symptoms disappeared promptly without recurrence of symptoms after resuming antiretroviral medications without tenofovir.
CONCLUSION
Distal renal tubular acidosis caused by tenofovir, without renal impairment is very rare. Since causes of nausea and vomiting among HIV/AIDS patients are very diverse, awareness of this phenomenon is useful in diagnosing and managing the problem.
背景
替诺福韦是一种用于治疗人类免疫缺陷病毒（HIV）感染的抗逆转录病毒药物，已知会导致近端肾小管酸中毒，如范科尼综合征，但远端肾小管酸中毒的病例此前从未有过报道。
病例介绍
一名20岁的HIV感染男性在开始抗逆转录病毒治疗后出现恶心和呕吐，但无腹泻。动脉血气分析显示非阴离子间隙代谢性酸中毒，尿液检查显示尿阴离子间隙阳性。患者所服用的抗逆转录病毒药物之一替诺福韦被认为是此次酸中毒的原因，所有抗逆转录病毒药物均被停用。症状迅速消失，在重新服用不含替诺福韦的抗逆转录病毒药物后症状未复发。
结论
由替诺福韦引起的无肾功能损害的远端肾小管酸中毒非常罕见。由于HIV/AIDS患者恶心和呕吐的原因非常多样，认识到这一现象有助于诊断和处理该问题。
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